“It’s All About the Patient” Improving Quality of Care with Engineered Nursing Ratios Prepared by: The HIMSS Nurse Staffing Ratio Work Group February 15, 2008 Copyright 2007 by the Healthcare Information and Management Systems Society (HIMSS)

“Patient Safety and Quality Patient Care can be enhanced through the collaborative efforts of all HIMSS communities to provide useful and effective information technology, enhanced processes, and appropriately designed staffing ratios for Nursing Staff” HIMSS Position Statement: Legislatively Mandated Patient to Nurse Ratios. Adopted by the HIMSS Board of Directors June 9,2006. Retrieved September 2, 2007.

Challenge Current federal and state legislation exists that would mandate staffing ratios that are fixed and universal. 3 Powerful Nurses Unions have just formed to “organize all non-union direct care RNs” and form a national voice around RN- patient staffing ratios ANA is underfunded to combat fixed staffing ratios in all states

HIMSS Position Statement HIMSS does not support legislatively-mandated nurse-to-patient ratios that are fixed and universal. HIMSS supports hospitals voluntarily applying flexible evidence-based ratios informed by research and local knowledge. HIMSS Position Statement: Legislatively Mandated Patient to Nurse Ratios. Adopted by the HIMSS Board of Directors June 9, 2006. Retrieved September 2, 2007.

In summary, research suggests … Effective nurse staffing is important to patient outcomes However, fixed nurse-to-patient ratios cannot address the issues unique to every hospital, such unit layout, support services, technological support, and nurse staffing mix Legislation to mandate fixed ratios carries a high potential of leading to the economic and political devaluation of the Nursing profession and fails to effectively deal with the issues surrounding nurse staffing Multi-site research suggests……….

In summary, research suggests … Lower patient-to-nurse ratios may be associated with Reduced failure-to-rescue Reduced mortality Reduced nosocomial septicemia in NICU Diminished RN burnout Increased RN job satisfaction Effective nurse staffing is important to patient outcomes Mandated fixed nurse-to-patient ratios cannot address the issues unique to every hospital, such as unit layout, support services, technological support, and staffing mix Multi-site research suggests……….

Solution: Engineered Staffing Ratios Engineered staffing ratios provide: Objective measures of patient acuity based upon the local patient care delivery model & standards of care Outcomes that respect unit-based geographic delimiters Outcomes that respect unique patient populations of the hospital Outcomes that respect fiscal and community constraints of the hospital Outcomes & recommendations sensitive to indirect HPPD practices & policies

Engineered Staffing Ratios (cont.) Outcomes that respect the availability of ancillary staff Hours & days ancillary support is available Unit-based vs. central pharmacy support Outcomes that respect availability of support staff on the unit Outcomes that respect available information systems Bed management systems Staffing and scheduling systems EMR CPOE – and physician adoption

HIMSS and Engineered Standards Integrating the HIMSS disciplines of IT, Management Engineering and Nursing facilitates the use of properly engineered staffing ratios Working in tandem with the Nursing profession, management engineers and nurses have created acuity measurement systems which can be used to more precisely determine the workload impact of each individual patient in order to balance safe patient to nurse ratios Through the effective use of technology and process improvement applications, the life of the nurse can be made easier The HIMSS disciplines of IT, Management Engineering and Nursing working together facilitate the use of properly engineered staffing ratios.

Summary The patient must remain the focus! Improved patient care outcomes is a shared goal Optimal nurse staffing can improve patient outcomes Staffing plans qualified through the metrics of engineered staffing systems will provide the most effective match between available resources and desired patient outcomes